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Economic Burden of Surgical Site Infections at a European University Hospital

Published online by Cambridge University Press:  02 January 2015

Walter P. Weber
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Marcel Zwahlen
Affiliation:
Research Support Unit, Institute of Social and Preventive Medicine, University of Bern, Switzerland
Stefan Reck
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Chantal Feder-Mengus
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Heidi Misteli
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Rachel Rosenthal
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Daniel Brandenberger
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Daniel Oertli
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
Andreas F. Widmer
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
Walter R. Marti*
Affiliation:
Department of General Surgery, University Hospital of Basel, Switzerland
*
Department of General Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland ([email protected])

Abstract

Objective.

To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.

Design.

Matched case-control study nested in a prospective observational cohort study.

Setting.

Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.

Methods.

All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.

Results.

A total of 6,283 procedures were performed:187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492–SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13–20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1–9.6 days). Differences were primarily attributable to organ space SSIs (n = 76).

Conclusions.

Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250278.CrossRefGoogle ScholarPubMed
2.Clements, AC, Tong, EN, Morton, AP, Whitby, M. Risk stratification for surgical site infections in Australia: evaluation of the US National Nosocomial Infection Surveillance risk index. J Hosp Infect 2007;66:148155.CrossRefGoogle ScholarPubMed
3.Fiorio, M, Marvaso, A, Vigano, F, Marchetti, F. Incidence of surgical site infections in general surgery in Italy. Infection 2006;34:310314.Google Scholar
4.Kaye, KS, Schmit, K, Pieper, C, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005;191:10561062.Google Scholar
5.Neumayer, L, Hosokawa, P, Itani, K, El-Tamer, M, Henderson, WG, Khuri, SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204:11781187.CrossRefGoogle ScholarPubMed
6.Vuorisalo, S, Haukipuro, K, Pokela, R, Syrjala, H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998;19:240247.CrossRefGoogle ScholarPubMed
7.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S157S.CrossRefGoogle ScholarPubMed
8.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206215.CrossRefGoogle ScholarPubMed
9.Brandt, C, Sohr, D, Behnke, M, Daschner, F, Ruden, H, Gastmeier, P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:13471351.Google Scholar
10.Finkelstein, R, Rabino, G, Mashiah, T, et al. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control 2005;33:450454.CrossRefGoogle ScholarPubMed
11.Gastmeier, P, Geffers, C, Brandt, C, et al. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 2006;64:1622.CrossRefGoogle ScholarPubMed
12.Geubbels, EL, Nagelkerke, NJ, Mintjes-De Groot, AJ, Vandenbroucke-Grauls, CM, Grobbee, DE, De Boer, AS. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 2006;18:127133.Google Scholar
13.Molina-Cabrillana, J, Chirino, CA, Rodriguez-Alvarez, JP, et al. Effect of surveillance on surgical site infection rate in knee and hip arthroplasty [in Spanish]. Rev Clin Esp 2007;207:388393.Google Scholar
14.Rioux, C, Grandbastien, B, Astagneau, P. Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. J Hosp Infect 2007;66:217223.CrossRefGoogle ScholarPubMed
15.Sykes, PK, Brodribb, RK, McLaws, ML, McGregor, A. When continuous surgical site infection surveillance is interrupted: the Royal Hobart Hospital experience. Am J Infect Control 2005;33:422427.CrossRefGoogle ScholarPubMed
16.Vilar-Compte, D, Roldan-Marin, R, Robles-Vidal, C, Volkow, P. Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies. Infect Control Hosp Epidemiol 2006;27:829834.CrossRefGoogle ScholarPubMed
17.Yasunaga, H, Ide, H, Imamura, T, Ohe, K. Accuracy of economic studies on surgical site infection. J Hosp Infect 2007;65:102107.CrossRefGoogle ScholarPubMed
18.Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Borriello, P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93103.CrossRefGoogle ScholarPubMed
19.Coskun, D, Aytac, J, Aydinli, A, Bayer, A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect 2005;60:176179.CrossRefGoogle Scholar
20.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.Google Scholar
21.Hollenbeak, CS, Murphy, DM, Koenig, S, Woodward, RS, Dunagan, WC, Fraser, VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118:397402.Google Scholar
22.Jenney, AW, Harrington, GA, Russo, PL, Spelman, DW. Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg 2001;71:662664.CrossRefGoogle ScholarPubMed
23.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.CrossRefGoogle ScholarPubMed
24.McGarry, SA, Engemann, JJ, Schmader, K, Sexton, DJ, Kaye, KS. Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol 2004;25:461467.CrossRefGoogle ScholarPubMed
25.Ortona, L, Federico, G, Fantoni, M, Pallavicini, F, Ricci, F, Antinori, A. A study on the incidence of postoperative infections and surgical sepsis in a university hospital. Infect Control 1987;8:320324.CrossRefGoogle Scholar
26.Poulsen, KB, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect 1994;113:283295.Google Scholar
27.Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504510.Google Scholar
28.Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183189.CrossRefGoogle Scholar
29.Fry, DE. The economic costs of surgical site infection. Surg Infect (Larchmt) 2002;3(suppl 1):S37S43.Google Scholar
30.Berry, DA, Lindgren, BW. Statistics: Theory and Methods. 2nd ed. Belmont, CA: Duxbury Press; 1996.Google Scholar
31.Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Piatt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.Google Scholar
32.Petherick, ES, Dalton, JE, Moore, PJ, Cullum, N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis 2006;6:170.Google Scholar
33.Mannien, J, Wille, JC, Snoeren, RL, van den, HS. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands. Infect Control Hosp Epidemiol 2006;27:809816.CrossRefGoogle Scholar
34.Monge Jodra, V, Sainz de Los Terreros Soler, L, Diaz-Agero, C, Saa Requejo, CM, Plana Farras, N. Excess length of stay attributable to surgical site infection following hip replacement: a nested case-control study. Infect Control Hosp Epidemiol 2006;27:12991303.Google Scholar
35.Alfonso, JL, Pereperez, SB, Canoves, JM, Martinez, MM, Martinez, IM, Martin-Moreno, JM. Are we really seeing the total costs of surgical site infections? A Spanish study. Wound Repair Regen 2007;15:474481.CrossRefGoogle ScholarPubMed
36.Delgado-Rodriguez, M, Medina-Cuadros, M, Bueno-Cavanillas, A, Martinez-Gallego, G, Dierssen, T, Sillero-Arenas, M. Comparison of two procedures to estimate the hospital stay attributable to nosocomial infection: matched cohort study versus analysis of covariance of the total unmatched cohort. J Clin Epidemiol 1997;50:773778.CrossRefGoogle ScholarPubMed